Provider Demographics
NPI:1003947979
Name:RUTHERFORD HOSPITAL INC
Entity Type:Organization
Organization Name:RUTHERFORD HOSPITAL INC
Other - Org Name:RUTHERFORD EAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-286-5000
Mailing Address - Street 1:607 120 HWY
Mailing Address - Street 2:
Mailing Address - City:MOORESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28114
Mailing Address - Country:US
Mailing Address - Phone:828-453-7455
Mailing Address - Fax:828-453-9490
Practice Address - Street 1:607 120 HWY
Practice Address - Street 2:
Practice Address - City:MOORESBORO
Practice Address - State:NC
Practice Address - Zip Code:28114
Practice Address - Country:US
Practice Address - Phone:828-453-7455
Practice Address - Fax:828-453-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC071773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7150008102701OtherSTATE TAX ID #
NC0815380Medicaid
BR5962875OtherDEA REGISTRATION #
NC7150008102701OtherSTATE TAX ID #